Use of the 3-vessel view to record Doppler velocity waveforms from the aortic isthmus in normally grown and growth-restricted fetuses: comparison with the long aortic arch view.
OBJECTIVE
Aortic isthmus (AoI) velocity waveforms are considered powerful indicators of hemodynamic deterioration in intrauterine growth-restricted (IUGR) fetuses. However, technical difficulties in sampling AoI velocity waveforms from the longitudinal aortic arch (LAA) have limited its clinical application thus far. In this study, we tested the possibility of recording AoI velocity waveforms from the 3-vessel (3V) view of the fetal mediastinum and comparing the agreement of these measurements with recordings from the LAA.


METHODS
Doppler measurements of the pulsatility index (PI) from the AoI were performed in 70 fetuses (20 IUGR and 50 normally grown) between 20 and 34 weeks' gestation. All measurements were sampled in both the LAA and 3V views by the same investigator. Reliability was evaluated with intraclass correlation coefficients (ICCs), and Bland-Altman plots were generated. The time required to complete the measurements was compared.


RESULTS
A high degree of reliability was observed between PI values obtained from LAA and 3V views in both IUGR and normally grown fetuses (all fetuses: ICC, 0.976; 95% confidence interval [CI], 0.961-0.985; normally grown: ICC, 0.839; 95% CI, 0.731-0.906; IUGR: ICC, 0.954; 95% CI, 0.886-0.982). However, recordings from the 3V view were significantly less time-consuming than those from the LLA view (mean +/- SD, 30.4 +/- 14.2 versus 52.8 +/- 29.4 seconds; P < .0001) and showed higher intraobserver reproducibility.


CONCLUSIONS
In IUGR and normally grown fetuses, AoI waveforms can be reliably obtained from the 3V view with higher reproducibility and a shorter recording time.
Rizzo
Giuseppe
G
Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli San Giovanni Calabita Hospital, Rome, Italy. giuseppe.rizzo@uniroma2.it
Capponi
Alessandra
A
Vendola
Marianne
M
Pietrolucci
Maria Elena
ME
Arduini
Domenico
D
D001011:Aorta / Q000000981:diagnostic imaging* / Q000196:embryology*; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*